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NPI Code Detail

MEDICARE: BIG THOMPSON MEDICAL GROUP INC.

MEDICARE: BIG THOMPSON MEDICAL GROUP INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275823510
Entity Type Code : Organization
Provider Name (Legal Business Name) : BIG THOMPSON MEDICAL GROUP INC.
Provider Business Mailing Address
First Line : 1627 E 18TH ST
Second Line :
City : LOVELAND
State : CO
Zip : 80538-4209
Country : US
Telephone Number : 970-663-0135
Fax Number : 970-461-1422
Provider Business Practice Location Address
First Line : 1813 CHEYENNE AVE
Second Line :
City : LOVELAND
State : CO
Zip : 80538-4244
Country : US
Telephone Number : 970-203-6801
Fax Number : 970-203-6821
Authorized Official
Title or Position : SR VP FINANCE
Name : DENNIS E DAHLEN
Credential :
Telephone Number : 602-747-4000
Provider Enumeration Date : 04/07/2011
Last Update Date : 04/27/2011

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